Metastatic Melanoma: Larry Hegland's Story

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Dermatologist examines a mole

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Too much time in the sun without proper protection can have an immediate consequence: sunburn. But the damage of UV rays doesn't stop at the skin's surface. One in five Americans will develop skin cancer, and one in 50 will be diagnosed with melanoma, the most serious type of skin cancer, over the course of a lifetime. In the past, people with melanoma spreading to other parts of the body (metastatic) faced slim chances of recovery. Now the Food and Drug Administration (FDA) has approved a new treatment emerging from research at Huntsman Cancer Institute that brings new hope to people with this diagnosis.

Larry Hegland has firsthand experience with metastatic melanoma. A red spot under his thumbnail that kept getting bigger was diagnosed as melanoma. While most melanomas occur in areas of the body often exposed to the sun, his was not. "You can get melanoma where the sun don't shine. You can get melanoma anywhere on your body," Larry says.

To get rid of the cancer, Larry's doctors removed his thumb and all the lymph nodes under his arm. Wary of any cancer cells that might linger in his body, doctors treated Larry with interferon to prevent the melanoma from coming back. Five and a half months of treatment was brutal on Larry's body and his state of mind.

"I lost about 80, 85 pounds," Larry said. "I had no strength. I was a mess. I prayed to die many times, because it hurt. I told them no more." He quit the treatment, and four months later the melanoma came back. "I said I will not have interferon," Larry said. "If I die, I die."

Not long after the melanoma returned, Larry met Dr. Robert Andtbacka, a surgical oncologist at Huntsman Cancer Institute. Dr. Andtbacka says 10 to 15 years ago, a metastatic or stage IV melanoma diagnosis was often a death sentence. "For those patients, the median survival was about 18 months, sometimes even shorter than that." To put the severity of the disease in perspective, fewer than one in ten patients survived for five years or longer after diagnosis.

Dr. Andtbacka pioneered the research behind the new FDA-approved treatment. It works by injecting a genetically modified cold sore virus into a tumor, which helps activate the immune system. The tumor cells burst open, exposing the cancer proteins inside to the immune system. Once the immune system has dealt with the tumor cells, it can recognize and kill cancer cells that may have spread elsewhere in the body.

The treatment causes minimal side effects for most patients. "The only major side effect we see is a bit of redness where we do the injection, a bit of discomfort," says Dr. Andtbacka. "Sometimes a bit of shakes and chills, same as when you get a flu shot, but otherwise it's very well-tolerated."

Well-tolerated, and well-received by Larry's body. After several rounds of injections, he's now cancer-free. "I thank God and Dr. Andtbacka and his team for saving my life. I'm so grateful," Larry said, with tears in his eyes.

Dr. Andtbacka's research on melanoma treatments continues, but he stresses the importance of prevention. "The main reason people get melanoma is because of sun exposure," says Dr. Andtbacka.

He adds that a suntan shouldn't be viewed as a sign of health. "Patients who get a suntan or a sunburn, it's really because the skin is saying 'you're hurting me, I need to protect myself.'"

Early diagnosis is also important. Dr. Andtbacka said that 70 percent of the time melanoma starts in a new lesion, not a mole you've had for years. "We know that the earlier we can diagnose melanoma, the lower the risk of having it spread," he adds. Annual full-body skin cancer screening exams are an important tool for early diagnosis.

New therapies have Dr. Andtbacka optimistic for the future. "I've been treating patients with melanoma for over ten years. When I first started doing this, we had very few treatment options that worked. Now we see patients such as Larry, whose melanoma goes away completely. We're really hoping it stays away completely as well."

Huntsman Cancer Institute (HCI) is a National Cancer Institute (NCI)-Designated Comprehensive Cancer Center, which means it meets the highest standards for cancer research and receives support for its scientific endeavors. HCI is located on the campus of the University of Utah in Salt Lake City and is a part of the University of Utah Health Care system. HCI treats patients with all forms of cancer and operates several high-risk clinics that focus on melanoma and breast, colon, and pancreas cancers, among others. HCI also provides academic and clinical training for future physicians and researchers. For more information about HCI, please visit www.huntsmancancer.org